U.K. and its shift toward value-based population health

BOSTON--Healthcare challenges facing the U.K. aren’t that different from the U.S. Rising healthcare costs, quality issues, integration failures and lack of patient voice all are impeding progress, and the U.K. is beginning to tackle these issues head on, said Mark Davies, MD, who recently stepped down as executive medical director of the Health & Social Care Information Centre. He spoke at the Medical Informatics World Conference on April 29.

“It’s gotten to a point of crisis where we can no longer continue to do what we currently do,” said Davies in his first talk since leaving his government role. “Models of delivery have to change.”

Improving quality by systematically measuring outcomes is central to transforming healthcare and moving U.K.’s National Health Service (NHS) to a value-based system. Integration—“one that reflects journeys and experiences of patients”—is part of this transformation, he said. “Patient voice is a profound change and information is central to those changes."

Davies cited a range of shifts occurring at NHS. Current reforms include decentralizing power so communities have a greater say over handling their own population health needs.

This means more decision making and purchasing power for local communities, or clinical commissioning groups (CCGs), with $70 billion of NHS’s $115 billion budget now getting directed to them, he said.

CCGs, clinically led groups that include all of the general practitioner groups in a particular geographical area of about 300,000 people, aim to give clinicians the power to influence commissioning decisions for their patients.

This move represents a shift in power from those providing care to those planning for care, said Davies. “It’s a significant shift, and let me tell you, it’s been painful.”

Now “everyone is talking about” the linkage between costs and quality, and the U.K. has activated an indicator assurance process, which ensures that only high quality indicators are developed by government agencies and organizations, he said.

Wirral CCG launched an analysis program that revealed spending patterns among physicians and how they measured up compared to outcomes.

“This is a good way to prioritize. And they did this in a transparent way to show the community areas they need to work together on,” he said.

Future success at NHS depends on measuring quality and identifying care gaps, and this requires effective IT systems that include information support and clinical decision support.

Without quality measurement, continuous improvement is put in jeopardy. Letting the healthcare industry experiment without capturing outcomes or measuring quality means the system won’t learn. “It's ethically indefensible and unsustainable,” he said.

Looking to the future, Davies said he is excited about big data, as organizations move from harnessing data for hindsight and insight to the direction of foresight.

“I look forward to the days when we can do prescriptive analytics,” he said.